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McKenzie-Sampson S, Baer RJ, Chambers Butcher BD, Jelliffe-Pawlowski LL, Karasek D, Oltman SP, Riddell CA, Rogers EE, Torres JM, Blebu BE. Risk of Adverse Perinatal Outcomes Among African-born Black Women in California, 2011-2020. Epidemiology 2024; 35:517-526. [PMID: 38567905 DOI: 10.1097/ede.0000000000001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND African-born women have a lower risk of preterm birth and small for gestational age (SGA) birth compared with United States-born Black women, however variation by country of origin is overlooked. Additionally, the extent that nativity disparities in adverse perinatal outcomes to Black women are explained by individual-level factors remains unclear. METHODS We conducted a population-based study of nonanomalous singleton live births to United States- and African-born Black women in California from 2011 to 2020 (n = 194,320). We used age-adjusted Poisson regression models to estimate the risk of preterm birth and SGA and reported risk ratios (RR) and 95% confidence intervals (CI). Decomposition using Monte Carlo integration of the g-formula computed the percentage of disparities in adverse outcomes between United States- and African-born women explained by individual-level factors. RESULTS Eritrean women (RR = 0.4; 95% CI = 0.3, 0.5) had the largest differences in risk of preterm birth and Cameroonian women (RR = 0.5; 95% CI = 0.3, 0.6) in SGA birth, compared with United States-born Black women. Ghanaian women had smaller differences in risk of preterm birth (RR = 0.8; 95% CI = 0.7, 1.0) and SGA (RR = 0.9; 95% CI = 0.8, 1.1) compared with United States-born women. Overall, we estimate that absolute differences in socio-demographic and clinical factors contributed to 32% of nativity-based disparities in the risk of preterm birth and 26% of disparities in SGA. CONCLUSIONS We observed heterogeneity in risk of adverse perinatal outcomes for African- compared with United States-born Black women, suggesting that nativity disparities in adverse perinatal outcomes were not fully explained by differences in individual-level factors.
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Affiliation(s)
- Safyer McKenzie-Sampson
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Rebecca J Baer
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | | | - Laura L Jelliffe-Pawlowski
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | - Deborah Karasek
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
| | - Scott P Oltman
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | - Corinne A Riddell
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA
| | - Jacqueline M Torres
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | - Bridgette E Blebu
- Department of Obstetrics and Gynecology, Lundquist Institute/Harbor-UCLA, University of California, Los Angeles, CA
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2
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Matoba N, Kim C, Branche T, Collins JW. Social Determinants of Premature Birth. Clin Perinatol 2024; 51:331-343. [PMID: 38705644 DOI: 10.1016/j.clp.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Social determinants of health have received increasing attention in public health, leading to increased understanding of how social factors-individual and contextual-shape the health of the mother and infant. However, racial differences in birth outcomes persist, with incomplete explanation for the widening disparity. Here, we highlight the social determinants of preterm birth, with special attention to the social experiences among African American women, which are likely attributed to structural racism and discrimination throughout life.
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Affiliation(s)
- Nana Matoba
- Division of Neonatology, Rady Children's Hospital San Diego, Department of Pediatrics, University of California San Diego, 3020 Children's Way, MC 5008, San Diego, CA 92123, USA.
| | - Christina Kim
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, 225 East Chicago Avenue, Box #45, Chicago, IL 60611, USA
| | - Tonia Branche
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, 225 East Chicago Avenue, Box #45, Chicago, IL 60611, USA
| | - James W Collins
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, 225 East Chicago Avenue, Box #45, Chicago, IL 60611, USA
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3
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Ding W, Xu Y, Kondracki AJ, Sun Y. Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:315-329.e31. [PMID: 37820985 DOI: 10.1016/j.ajog.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events. DATA SOURCES PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022. STUDY ELIGIBILITY CRITERIA Observational cohort, cross-sectional, and case-control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English. METHODS Two reviewers independently screened studies, obtained data, and assessed study quality, and conflicts were resolved by a third reviewer. Dichotomous outcomes were evaluated using meta-analysis, and pooled odds ratios and 95% confidence intervals were generated using random-effects models. Moderation analysis and meta-regression were used to investigate heterogeneity. RESULTS In total, 21 cohort studies, 9 cross-sectional studies, and 3 case-control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33-2.76; I2=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23-2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14-3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88-8.30; I2=99.9%; P<.001). Considerable heterogeneity (I2>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance. CONCLUSION The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.
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Affiliation(s)
- Wenqin Ding
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Yuxiang Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Anthony J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA
| | - Ying Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.
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4
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Major-Kincade TL. Obstetric Racism, Education, and Racial Concordance. MCN Am J Matern Child Nurs 2024; 49:74-80. [PMID: 38108513 DOI: 10.1097/nmc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
ABSTRACT The United States holds the distinction of being the developed country with the worst perinatal outcomes despite spending the most per capita on health care. Black women are three to four times more likely than White women to experience adverse birth outcomes. These outcomes persist despite access to prenatal care, insurance, and college education. A long overdue racial reckoning has arrived, beginning with acknowledging the fallacy of race-based medicine and the role of enduring systemic racism as foundational to obstetric racism in the reproductive lives of Black women. Centering voices of Black women and honoring their lived experiences are essential to providing respectful maternity care. Naming micro- and macroaggressions experienced by Black women allows for dismantling of systemic barriers which perpetuate inequitable outcomes and enable substandard care. Racial concordance (shared racial identity) is one tool to consider in creating safe health care spaces for Black women. Improving diversity of the nursing workforce specifically, and the health care workforce in general, is necessary to affect racial concordance. Application of skills in cultural humility can mitigate challenges associated with adverse patient encounters for Black women as diversity pipeline strategies are explored. Histories of foundational fallacy, their impact on care and outcomes, and patient-driven indicators for improving pregnancy care experiences for women of color are explored through the lens of a Black physician and the collective reproductive health workforce.
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Affiliation(s)
- Terri L Major-Kincade
- Terri L. Major-Kincade is an Associate Professor, Department of Pediatrics, Director, Pediatric Palliative Care Service Memorial Hermann Children's Hospital, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX. Dr. Major-Kincade can be reached at
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5
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Jones DS, Hammonds E, Gone JP, Williams D. Explaining Health Inequities - The Enduring Legacy of Historical Biases. N Engl J Med 2024; 390:389-395. [PMID: 38284897 DOI: 10.1056/nejmp2307312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- David S Jones
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
| | - Evelynn Hammonds
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
| | - Joseph P Gone
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
| | - David Williams
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
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6
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Braveman P, Heck K, Dominguez TP, Marchi K, Burke W, Holm N. African immigrants' favorable preterm birth rates challenge genetic etiology of the Black-White disparity in preterm birth. Front Public Health 2024; 11:1321331. [PMID: 38239790 PMCID: PMC10794556 DOI: 10.3389/fpubh.2023.1321331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Background We examined over a million California birth records for 2010 through 2021 to investigate whether disparities in preterm birth (PTB) by nativity and race support the widely held but hitherto unsubstantiated belief that genetic differences explain the persistent Black-White disparity in PTB. Methods We examined PTB rates and risk ratios among African-, Caribbean-, and U.S.-born Black women compared to U.S.-born White women. Multivariate analyses adjusted for maternal age, education, number of live births, delivery payer, trimester of prenatal care initiation, pre-pregnancy BMI, smoking, and prevalence of poverty in a woman's residence census tract; and for paternal education. Results In adjusted analyses, African-born Black women's PTB rates were no different from those of U.S.-born White women. Discussion The results add to prior evidence making a genetic etiology for the racial disparity in PTB unlikely. If genetic differences tied to "race" explained the Black-White disparity in PTB among U.S.-born women, the African immigrants in this study would have had higher rates of PTB, not the lower rates observed. Multiple explanations for the observed patterns and their implications are discussed. Failure to distinguish causes of PTB from causes of the racial disparity in PTB have likely contributed to erroneous attribution of the racial disparity to genetic differences. Based on the literature, unmeasured experiences of racism, including racism-related stress and adverse environmental exposures, are plausible explanations for the PTB disparity between Black and White U.S.-born women. The favorable birth outcomes of African-born Black immigrants may reflect less exposure to racism during sensitive life periods, e.g., childhood, when they were in African countries, where Black people are in the racial majority.
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Affiliation(s)
- Paula Braveman
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Heck
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Tyan Parker Dominguez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Kristen Marchi
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, DC, United States
| | - Nicole Holm
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
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7
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Clay SL, Ibe-Lamberts K, Kelly KD, Nii-Aponsah H, Woodson MJ, Tines F, Mehdi SA. US-Born Black Women and Black Immigrant Women: an Exploration of Disparities in Health Care and Sociodemographic Factors Related to Low Birth Weight. J Racial Ethn Health Disparities 2023; 10:3031-3038. [PMID: 36449128 DOI: 10.1007/s40615-022-01477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This study explores whether nativity differences in health care and sociodemographic factors help to account for nativity differences in low birth weight (LBW) when comparing US-born Black women (USBW) to Black Immigrant women (BIW). METHODS Bivariate analyses and multinomial nested logit (MNL) models were performed using the National Survey of Family Growth (NSFG) dataset. RESULTS Statistically significant nativity differences between USBW and BIW were found across variables of LBW (p = .009), marital status (p < .001), education level (p < .001), receiving public assistance (p < .001), health care coverage (p < .001), age (p < .001), and poverty level income (p < .001). Results from the MNL models indicated that BIW were 91% less likely to have a LBW baby (p < .001). When accounting for other sociodemographic and health care related variables differing by nativity, although a statistically significant, narrowing gap between BIW and USBW was observed (OR = .12, p < .001), BIW were still less likely to have a LBW baby. CONCLUSIONS Differences between USBW and BIW across sociodemographic variables and health care related factors related to adverse pregnancy outcomes were observed in this study. Controlling for the factors attenuated nativity differences but did not eliminate the differences on LBW. Future research should continue to explore this relationship.
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Affiliation(s)
- Shondra Loggins Clay
- School of Interdisciplinary Health Professions (SIHP), Northern Illinois University, 370 Wirtz Drive, 323D Wirtz Hall, Dekalb, IL, 60115, USA.
| | - Kelechi Ibe-Lamberts
- Division of Community Health Sciences, School of Public Health, University of Illinois-Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
| | - Kelsie D Kelly
- Department of Public Health Sciences, School of Medicine, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22903, USA
| | - Harold Nii-Aponsah
- School of Interdisciplinary Health Professions (SIHP), Northern Illinois University, 370 Wirtz Drive, 323D Wirtz Hall, Dekalb, IL, 60115, USA
| | - Markisha J Woodson
- Department of Public Health, College of Science and Health, Benedictine University, 5700 College Road, Lisle, IL, 60532, USA
| | - Francesca Tines
- School of Interdisciplinary Health Professions (SIHP), Northern Illinois University, 370 Wirtz Drive, 323D Wirtz Hall, Dekalb, IL, 60115, USA
| | - Syed Abbas Mehdi
- Department of Public Health, College of Science and Health, Benedictine University, 5700 College Road, Lisle, IL, 60532, USA
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8
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Fraiman YS, Guyol G, Acevedo-Garcia D, Beck AF, Burris H, Coker TR, Tiemeier H. A Narrative Review of the Association between Prematurity and Attention-Deficit/Hyperactivity Disorder and Accompanying Inequities across the Life-Course. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1637. [PMID: 37892300 PMCID: PMC10605109 DOI: 10.3390/children10101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Preterm birth is associated with an increased risk of neurodevelopmental and neurobehavioral impairments including attention-deficit/hyperactivity disorder (ADHD), the most common neurobehavioral disorder of childhood. In this narrative review, we examine the known associations between prematurity and ADHD and highlight the impact of both prematurity and ADHD on multiple domains across the pediatric life-course. We develop a framework for understanding the health services journey of individuals with ADHD to access appropriate services and treatments for ADHD, the "ADHD Care Cascade". We then discuss the many racial and ethnic inequities that affect the risk of preterm birth as well as the steps along the "ADHD Care Cascade". By using a life-course approach, we highlight the ways in which inequities are layered over time to magnify the neurodevelopmental impact of preterm birth on the most vulnerable children across the life-course.
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Affiliation(s)
- Yarden S. Fraiman
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Genevieve Guyol
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02218, USA
| | - Dolores Acevedo-Garcia
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Andrew F. Beck
- Cincinnati Children’s, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Heather Burris
- Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tumaini R. Coker
- Seattle Children’s, University of Washington School of Medicine, Seattle, WA 98105, USA
| | - Henning Tiemeier
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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9
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Stevens DR, Yeung E, Hinkle SN, Grobman W, Williams A, Ouidir M, Kumar R, Lipsky LM, Rohn MCH, Kanner J, Sherman S, Chen Z, Mendola P. Maternal asthma in relation to infant size and body composition. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100122. [PMID: 37485032 PMCID: PMC10361394 DOI: 10.1016/j.jacig.2023.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background Asthma affects 10% of pregnancies and may influence offspring health, including infant size and body composition, through hypoxic and inflammatory pathways. Objective We sought to determine associations between maternal asthma and asthma phenotypes during pregnancy and infant size and body composition. Methods The B-WELL-Mom study (2015-19) is a prospective cohort of 418 pregnant persons with and without asthma recruited in the first trimester of pregnancy from 2 US obstetric clinics. Exposures were maternal self-reported active asthma (n = 311) or no asthma (n = 107), and asthma phenotypes were classified on the bases of atopy, onset, exercise induced, control, severity, symptomology, and exacerbations. Outcomes were infant weight, length, head circumference, and skinfold measurements at birth and postnatal follow-up, as well as fat and lean mass assessed by air displacement plethysmography at birth. Adjusted multivariable linear regression examined associations of maternal asthma and asthma phenotypes with infant outcomes. Results Offspring were born at a mean ± SD of 38 ± 2.3 weeks' gestation and were 18 ± 2.2 weeks of age at postnatal follow-up. Infants of participants with asthma had a mean ± SD fat mass of 11.0 ± 4.2%, birth weight of 3045.8 ± 604.3 g, and postnatal follow-up weight of 6696.4 ± 964.2 g, which were not different from infants of participants without asthma (respectively, β [95% confidence interval]: -0.1 [-1.4, 1.3], -26.7 [-156.9, 103.4], and 107.5 [-117.3, 332.3]). Few associations were observed between asthma or asthma phenotypes and infant size or body composition. Conclusions In a current obstetric cohort, maternal asthma during pregnancy was not associated with differential infant size or body composition.
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Affiliation(s)
- Danielle R. Stevens
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Edwina Yeung
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Stefanie N. Hinkle
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Andrew Williams
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks
| | - Marion Ouidir
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Rajesh Kumar
- Feinberg School of Medicine, Northwestern University, Chicago
| | - Leah M. Lipsky
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Matthew C. H. Rohn
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
- Department of Obstetrics and Gynecology, George Washington University, Washington
| | - Jenna Kanner
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | | | - Zhen Chen
- Biostatistics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Pauline Mendola
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo
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10
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Shaikh H, Billimoria Z, Vandeleur D, Weiss EM, Batra M, Hedstrom AB. Transmission of negative biases through social commentary included in neonatal intensive care unit progress notes. J Perinatol 2023; 43:903-908. [PMID: 36841888 PMCID: PMC9959939 DOI: 10.1038/s41372-023-01635-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To determine how the perception of families elicited after reading progress note social commentary differs by patient race. STUDY DESIGN We retrospectively performed content analysis of social commentary in physician progress notes for neonatal intensive care unit patients hospitalized from 2018-2019. Neonatologists blinded to patient race rated how commentary impacted their perception of the patient's family on a 5-point Likert scale. Frequency of negative ratings was compared across reported race using chi-squared tests. RESULTS We reviewed charts of 460 neonates. In total, 225 (49%) contained social commentary beyond parents' names. Twelve neonatologists rated how commentaries impacted their perception of the patient's family; 79%, 18%, and 3% were rated neutrally, negatively, and positively, respectively. Frequency of negative ratings was significantly greater among American Indian/Alaska Native than other patients (35% vs. 22%, p < 0.001). CONCLUSIONS Physician documentation of social commentary in patient notes may reflect and perpetuate implicit biases that contribute to race-based healthcare disparities.
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Affiliation(s)
- Henna Shaikh
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Zeenia Billimoria
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Daron Vandeleur
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Elliott M Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Maneesh Batra
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Anna B Hedstrom
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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11
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Evans CR, Nieves CI, Erickson N, Borrell LN. Intersectional inequities in the birthweight gap between twin and singleton births: A random effects MAIHDA analysis of 2012-2018 New York City birth data. Soc Sci Med 2023; 331:116063. [PMID: 37467517 DOI: 10.1016/j.socscimed.2023.116063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
Birthweight is a widely-used biomarker of infant health, with inequities patterned intersectionally by maternal age, race/ethnicity, nativity/immigration status, and socioeconomic status in the United States. However, studies of birthweight inequities almost exclusively focus on singleton births, neglecting high-risk twin births. We address this gap using a large sample (N = 753,180) of birth records, obtained from the 2012-2018 New York City (NYC) Department of Health and Mental Hygiene, Bureau of Vital Statistics, representing 99% of all births registered in NYC, and a novel random coefficients intersectional MAIHDA (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy) model. Our results show evidence of intersectional inequities in birthweight outcomes for both twin and singleton births by maternal age, race/ethnicity, education, and nativity status. Twins have considerably lower predicted birthweights than singletons overall (-930 g on average), and this is especially true for babies born to mothers who are younger (11-19 years), older (40+), racial/ethnic minoritized, foreign-born, and have lower education. However, the magnitude of this birthweight 'gap' between twins and singletons varies considerably across social identity strata, ranging between 830.8 g (observed among 40+ year old Black foreign-born mothers with high school degrees) and 1013.7 g (observed among 30-39 year old Hispanic/Latina foreign-born mothers with less than high school degrees). This study underscored the needs of a high-risk population and the need for aggressive social policies to address health inequities and dismantle intersectional systems of marginalization, oppression, and socioeconomic inequality. In addition to our substantive contributions, we add to the growing methods literature on intersectional quantitative analysis by demonstrating how to apply intersectional MAIHDA with random coefficients and random slopes. We conclude with a discussion of the significant potential for this methodological extension in future research on inequities.
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Affiliation(s)
- Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA.
| | - Christina I Nieves
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | | | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
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12
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Treder KM, Amutah-Onukagha N, White KO. Abortion Bans Will Exacerbate Already Severe Racial Inequities in Maternal Mortality. Womens Health Issues 2023:S1049-3867(23)00098-1. [PMID: 37301725 DOI: 10.1016/j.whi.2023.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Kelly M Treder
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Boston Medical Center, One Boston Medical Center Pl, Boston, Massachusetts.
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, Massachusetts
| | - Katharine O White
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Boston Medical Center, One Boston Medical Center Pl, Boston, Massachusetts
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13
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Matoba N, Collins JW, Dizon MLV. Fetal Origins of Health Disparities: Transgenerational Consequences of Racism. Dev Neurosci 2023; 46:112-118. [PMID: 37290414 DOI: 10.1159/000531462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Despite advances in perinatal medicine, racial disparity in birth outcomes remains a public health problem in the USA. The underlying mechanisms for this long-standing racial disparity are incompletely understood. This review presents transgenerational risk factors for racial disparities in preterm birth, exploring the impact of interpersonal and structural racism, theoretical models of stress, and biological markers of racial disparities.
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Affiliation(s)
- Nana Matoba
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Division of Neonatology, University of California San Diego, Rady Children's Hospital San Diego, San Diego, California, USA
| | - James W Collins
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L V Dizon
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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14
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Moody SN, Phan JM, Shirtcliff EA, Wang W, Drury S, Theall K. Transgenerational effect of Mothers' experiences of discrimination on Black youths' hormone coupling in response to laboratory stress. RESEARCH IN HUMAN DEVELOPMENT 2023; 20:25-47. [PMID: 37484485 PMCID: PMC10358998 DOI: 10.1080/15427609.2023.2215130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Exposure to pervasive racial discrimination of Black Americans is transgenerational in that mothers' experiences of discriminatory violence impacts their children. This study explored whether stress-related biomarkers reflect transgenerational racial stress by implementing a "dual activation" framework to probe how adrenal and gonadal hormones underlying adolescent development are co-regulated during a laboratory stressor. Data were collected from 120 Black families in the United States. Children completed the Trier Social Stress Task (TSST-C) and provided 4 saliva samples across 2 days that were assayed for cortisol (C), dehydroepiandrosterone (DHEA), and testosterone (T). Mothers reported their experiences of total discrimination and racial discrimination related to skin color/race. Thirty four percent reported experiences of discrimination and on average 46.7% reported experiences of discrimination due to their race or skin tone. Mothers' experiences of racial discrimination were associated with their child's hormonal reactivity to and recovery from the TSST-C. Youth showed stronger positive hormone coupling between C-T if their mother experienced greater discrimination. Mothers' experiences of racial discrimination influenced both C-T coupling and youths' cortisol recovery from the TSST-C. For youths with high testosterone, cortisol recovery was blunted. Results suggest that associations between racism and hormonal stress response may be transgenerational. Mothers' experiences of discrimination had a profound impact on their children's hormonal co-regulation.
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Affiliation(s)
- Shannin N. Moody
- Department of Neurology, Louisiana State University Health Sciences Center, New Orleans (LA), USA
- Department of Human Development and Family Studies, Iowa State University, Ames, (IA), USA
| | - Jenny M. Phan
- Center for Autism Spectrum Disorders, Children’s National Hospital, Washington (D.C.) USA
| | - Elizabeth A. Shirtcliff
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Wen Wang
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Stacy Drury
- Department of Pediatrics, Tulane University, New Orleans, (LA), USA
| | - Katherine Theall
- Departments of Social, Behavioral, and Population Sciences and Epidemiology, Tulane University, New Orleans, (LA), USA
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15
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Agbeko RS. Biology and Belonging. Pediatr Crit Care Med 2023; 24:344-347. [PMID: 37026725 DOI: 10.1097/pcc.0000000000003201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Rachel S Agbeko
- Department of Paediatric Intensive Care, Great North Children's Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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16
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BRAVEMAN PAULA. The Black-White Disparity in Preterm Birth: Race or Racism? Milbank Q 2023; 101:356-378. [PMID: 37096619 PMCID: PMC10126979 DOI: 10.1111/1468-0009.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/20/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Racism is an upstream determinant of health that influences health through many midstream and downstream factors. This Perspective traces multiple plausible causal pathways from racism to preterm birth. Although the article focuses on the Black-White disparity in preterm birth, a key population health indicator, it has implications for many other health outcomes. It is erroneous to assume by default that underlying biological differences explain racial disparities in health. Appropriate science-based policies are needed to address racial disparities in health; this will require addressing racism.
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17
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Gama RM, Bhaduri M, Atkins W, Nwankiti MK, Hutchison G, Thomas M, Clark K, Kelly CB, Dalrymple KV, Vincent RP, Kametas N, Bramham K. Ethnic disparities in pregnancy-related acute kidney injury in a United Kingdom population. J Nephrol 2023; 36:777-787. [PMID: 36635580 DOI: 10.1007/s40620-022-01516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/25/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The incidence of acute kidney injury in pregnancy (P-AKI) is rising and is associated with detrimental maternal and foetal outcomes. Ethnic disparities in pregnancy outcomes are well recognized, with females who identify as Black or Asian being more likely to die during pregnancy compared to females who identify as White ethnicity. METHODS This study reports rates of P-AKI and associated risk factors in pregnant females of different ethnicities. All pregnancies were recorded between 2016 and 2020. AKI episodes were identified using electronic alerts. Ethnicity, AKI stage (1-3), obstetric outcomes and risk factors for P-AKI (chronic hypertension, pregnancy-induced hypertension and pre-eclampsia, and haemorrhage) were assessed. RESULTS There were 649 P-AKI episodes from 16,943 deliveries (3.8%). Black females were more likely to have P-AKI (5.72%) compared to those who were White (3.12%), Asian (3.74%), mixed ethnicity (2.89%) and Other/Not Stated (3.10%). Black females, compared to White females, were at greater risk of developing P-AKI if they had haemorrhage requiring blood transfusion (OR 2.44, 95% CI 1.31,4.54; p < 0.001) or pregnancy-induced hypertension (OR 1.79, 95% CI 1.12, 2.86; p < 0.001). After adjusting for risk factors, Black females had increased risk of developing P-AKI (OR 1.52, 95% CI 1.22, 1.80; p < 0.001) compared to White females. Black females were at increased risk of developing P-AKI compared to White females. Mode of delivery, pregnancy-induced hypertension and haemorrhage are likely to have contributed. The increased risk persists despite accounting for these variables, suggesting that other factors such as socioeconomic disparities need to be considered. CONCLUSIONS The incidence of P-AKI is likely higher than previously stated in the literature. However, caution must be exercised, particularly with AKI stage 1, as the KDIGO system is not validated in pregnancy and gestational changes in renal physiology need to be considered. Pregnancy-specific AKI definitions are needed.
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Affiliation(s)
- Rouvick M Gama
- King's Kidney Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
| | - Mahua Bhaduri
- King's Fertility Unit, Fetal Medicine Research Institute, Windsor Walk, Denmark Hill, London, UK
| | - William Atkins
- King's Kidney Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Miss Kelly Nwankiti
- Department of Haematology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Gemma Hutchison
- Department of Obstetrics, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Mica Thomas
- Department of Obstetrics, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Katherine Clark
- Department of Females and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Clare B Kelly
- Centre of Public Health, Queen's University, Belfast, UK
| | - Kathryn V Dalrymple
- Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nick Kametas
- Harris Birthright Centre, Fetal Medicine Research Institute, Windsor Walk, Denmark Hill, London, UK
| | - Kate Bramham
- King's Kidney Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
- Department of Females and Children's Health, School of Life Course Sciences, King's College London, London, UK
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18
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Johnson A, Dobbs PD, Coleman L, Maness S. Pregnancy-Specific Stress and Racial Discrimination Among U.S. Women. Matern Child Health J 2023; 27:328-334. [PMID: 36609938 DOI: 10.1007/s10995-022-03567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/20/2022] [Accepted: 12/20/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Adverse birth outcomes among children born to women of color (WOC) have been associated with discrimination during pregnancy; however, little research has explored stressed caused by discrimination as well as pregnancy-specific stress. The purpose of this study was to examine differences in stress and racial discrimination (lifetime and during pregnancy) between U.S. women of different racial/ethnic groups. METHODS Women between 18 and 45 years (n = 198; 101 non-Hispanic White, 58 Black, and 39 other WOC [i.e., Hispanic, Asian/Pacific Islander, American Indian, Mixed Race]) completed an online, cross-sectional survey between December 2019 and March 2020. Participants reported pregnancy-specific stress using the pregnancy distress questionnaire (PDQ) and pregnancy life events scale (PLE) and discrimination via the general ethnic discrimination scale (GED). ANOVAs explored differences between racial/ethnic groups' stress and discrimination. RESULTS We found non-Hispanic White (p < 0.05) and other WOC (p < 0.01) reported higher distress during pregnancy than Black women, and other WOC (p < 0.05) reported more stressful prenatal life events (p < 0.05) than non-Hispanic Whites. However, Black (p < 0.001) and other WOC (p < 0.001) both experienced more ethnic discrimination throughout their lifetime and during their pregnancy than non-Hispanic Whites. Also, Black women experienced five times the stress from these encounters than White women (p < 0.001). CONCLUSIONS FOR PRACTICE Previously developed pregnancy distress questionnaires may be better suited for non-Hispanic White populations and may miss important experiences unique to marginalized populations such as racial/ethnic discrimination. Adaptations to pregnancy-related stress scales are warranted given the toxicity of discrimination during pregnancy.
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Affiliation(s)
- Aleyah Johnson
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA
| | - Page D Dobbs
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA.
- Human Performance and Recreation Department, University of Arkansas, 72701, Health, Fayetteville, AR, USA.
- Center for Public Health and Technology, University of Arkansas, 72701, Fayetteville, AR, USA.
| | - Lois Coleman
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA
- Department of Health Promotion Sciences, University of Oklahoma Health Science Center, Hudson College of Public Health, 73104, Oklahoma City, OK, USA
| | - Sarah Maness
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA
- College of Charleston, Public Health Department, 29424, Charleston, South Caroline, USA
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19
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Sonoko S, Mao Y, Biswas A, Amutha C, Amin Z, Cook AR, Lee J. Birth anthropometry among three Asian racial groups in Singapore: proposed new growth charts. Arch Dis Child 2023; 108:367-372. [PMID: 36593086 PMCID: PMC10176388 DOI: 10.1136/archdischild-2022-324693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/13/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We analysed birth anthropometry of babies of Chinese, Malay and Indian ancestry living in Singapore with an aim to develop gestational age (GA) and gender-specific birth anthropometry charts and compare these with the widely used Fenton charts. DESIGN Retrospective observational study. SETTING Department of Neonatology, National University Hospital, Singapore. POPULATION We report data from 52 220 infants, born between 1991-1997 and 2010-2017 in Singapore. METHODS Anthropometry charts were built using smoothened centile curves and compared with Fenton's using binomial test. Birth weight (BW), crown-heel length and head circumference (HC) were each modelled with maternal exposures using general additive model. MAIN OUTCOME MEASURES BW, crown-heel length and HC. RESULTS There were 22 248 Chinese (43%), 16 006 Malay (31%) and 8543 Indian (16%) babies. Mean BW was 3103 g (95% CI 3096 to 3109), 3075 g (95% CI 3067 to 3083) and 3052 g (95% CI 3041 to 3062) for Chinese, Malays and Indians, respectively. When exposed to a uniform socioeconomic environment, intrauterine growth and birth anthropometry of studied races were almost identical. From our GA-specific anthropometric charts until about late prematurity, Asian growth curves mirrored that of Fenton's; thereafter, Asian babies showed a reduction in growth velocity. CONCLUSIONS These findings suggest that Asian babies living in relatively uniform socioeconomic strata exhibit similar growth patterns. There is a slowing of growth among Asian babies towards term, prompting review of existing birth anthropometry charts. The proposed charts will increase accuracy of identification of true fetal growth restriction as well as true postnatal growth failure in preterm infants when applied to the appropriate population.
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Affiliation(s)
- Sensaki Sonoko
- Department of Neonatology, National University Health System, Singapore
| | - Yinan Mao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Agnihotri Biswas
- Department of Neonatology, National University Health System, Singapore.,Department of Paediatrics, National University of Singapore, Singapore
| | - Chinnadurai Amutha
- Department of Neonatology, National University Health System, Singapore.,Department of Paediatrics, National University of Singapore, Singapore
| | - Zubair Amin
- Department of Neonatology, National University Health System, Singapore.,Department of Paediatrics, National University of Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Jiun Lee
- Department of Neonatology, National University Health System, Singapore .,Department of Paediatrics, National University of Singapore, Singapore
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20
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Malinowska JK, Żuradzki T. Towards the multileveled and processual conceptualisation of racialised individuals in biomedical research. SYNTHESE 2022; 201:11. [PMID: 36591336 PMCID: PMC9795162 DOI: 10.1007/s11229-022-04004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
In this paper, we discuss the processes of racialisation on the example of biomedical research. We argue that applying the concept of racialisation in biomedical research can be much more precise, informative and suitable than currently used categories, such as race and ethnicity. For this purpose, we construct a model of the different processes affecting and co-shaping the racialisation of an individual, and consider these in relation to biomedical research, particularly to studies on hypertension. We finish with a discussion on the potential application of our proposition to institutional guidelines on the use of racial categories in biomedical research.
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Affiliation(s)
| | - Tomasz Żuradzki
- Institute of Philosophy & Interdisciplinary Centre for Ethics, Jagiellonian University, ul. Grodzka 52, 31-044 Kraków, Poland
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21
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Prematurity-associated wheeze: current knowledge and opportunities for further investigation. Pediatr Res 2022:10.1038/s41390-022-02404-1. [PMID: 36463364 PMCID: PMC10238677 DOI: 10.1038/s41390-022-02404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
Prematurity-associated wheeze is a common complication of preterm birth, with significant impact on the health and healthcare utilization of former preterm infants. This wheezing phenotype remains poorly understood and difficult to predict. This review will discuss the current state of the literature on prematurity-associated wheeze. We will discuss etiology and pathophysiology, and offer two conceptual models for the pathogenesis of this complex condition. This review will also identify current methods of ascertainment, and discuss the strengths and limitations of each. We will explore research-backed approaches to prevention and management, and finally suggest both pre-clinical and clinical avenues for investigation. An in-depth understanding of prematurity-associated wheeze will aid clinicians in its diagnosis and management, and inspire scientists to pursue much-needed further study into causes and prevention of this common and impactful condition. IMPACT: There is no recent, concise review on the current state of research on prematurity-associated wheeze, which is a rapidly evolving area of study. This article highlights causal models of wheeze, methods of ascertainment, management strategies for the clinician, and opportunities for further research for the physician scientist.
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22
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Thayer Z, Uwizeye G, McKerracher L. Toolkit article: Approaches to measuring social inequities in health in human biology research. Am J Hum Biol 2022; 34:e23804. [PMID: 36173013 DOI: 10.1002/ajhb.23804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023] Open
Abstract
Across populations, human morbidity and mortality risks generally follow clear gradients, with socially-disadvantaged individuals and groups tending to have higher morbidity and mortality at all life stages relative to those more socially advantaged. Anthropologists specialize in understanding the proximate and ultimate factors that shape variation in human biological functioning and health and are therefore well-situated to explore the relationships between social position and health in diverse ecological and cultural contexts. While human biologists have developed sophisticated methods for assessing health using minimally-invasive methods, at a disciplinary level, we have room for conceptual and methodological improvement in how we frame, measure, and analyze the social inequities that might shape health inequities. This toolkit paper elaborates on some steps human biologists should take to enhance the quality of our research on health inequities. Specifically, we address: (1) how to frame unequal health outcomes (i.e., inequalities vs. disparities vs. inequities) and the importance of identifying our conceptual models of how these inequities emerge; (2) how to measure various axes of social inequities across diverse cultural contexts, and (3) approaches to community collaboration and dissemination. We end by discussing (4) future directions in human biology research of health inequities, including understanding the ultimate causes of sensitivity to social inequities and transitioning from research to action.
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Affiliation(s)
- Zaneta Thayer
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire, USA
| | - Glorieuse Uwizeye
- Arthur Labatt School of Nursing, University of Western Ontario, London, Ontario, Canada
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23
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Karvonen KL, Goronga F, McKenzie-Sampson S, Rogers EE. Racial disparities in the development of comorbid conditions after preterm birth: A narrative review. Semin Perinatol 2022; 46:151657. [PMID: 36153273 DOI: 10.1016/j.semperi.2022.151657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite recognition and attempts to reduce racial disparities in perinatal outcomes, Black infants are still disproportionately represented among those who are born preterm. Postnatal investigations of racial disparities in comorbidities and outcomes after preterm birth are increasing, although their results and interpretations are conflicting. In the present review, we 1.) identify important methodological limitations of that literature 2.) summarize the conflicting literature investigating racial disparities, specifically Black-white differences, in postnatal comorbidities and outcomes after preterm birth 3.) describe mechanisms by which racism operates to contextualize our understanding to inform future work to actively reduce disparities in preterm birth and subsequently, its complications.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States.
| | - Faith Goronga
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States
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24
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Montoya-Williams D, Barreto A, Fuentes-Afflick E, Collins JW. Nativity and perinatal outcome disparities in the United States: Beyond the immigrant paradox. Semin Perinatol 2022; 46:151658. [PMID: 36137831 PMCID: PMC10016119 DOI: 10.1016/j.semperi.2022.151658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the United States (US), epidemiologists have long documented paradoxically lower rates of adverse perinatal health outcomes among immigrant birthing people than what might be expected in light of socioeconomic and language barriers to healthcare, especially as compared to their US-born racial and ethnic counterparts. However, researchers have also documented significant variability in this immigrant birth paradox when examining within and across racial and ethnic subgroups. This review paper summarizes fifty years of research regarding differences in low, preterm birth, and infant mortality in the US, according to the nativity status of the birthing person. While there is ample evidence of the importance of nativity in delineating a pregnant person's risk of adverse infant outcomes, this review also highlights the relative paucity of research exploring the intersection of acculturation, ethnic enclaves, and structural segregation. We also provide recommendations for advancing the study of perinatal outcomes among immigrants.
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Affiliation(s)
- Diana Montoya-Williams
- Assistant Professor of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Alejandra Barreto
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Research assistant, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Elena Fuentes-Afflick
- Professor of Pediatrics and Vice Dean, University of California, San Francisco, San Francisco, CA, USA
| | - James W Collins
- Professor of Neonatology, Department of Neonatology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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25
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Нагаева ЕВ. [Short stature due to intrauterine growth retardation. Clinical and hormonal-metabolic features, possibilities of growth-stimulating therapy]. PROBLEMY ENDOKRINOLOGII 2022; 68:4-13. [PMID: 36337013 PMCID: PMC9762449 DOI: 10.14341/probl13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
The article presents data about short stature due to intrauterine development delay. This type of short stature - separate nosology, unites children born small for gestation age. The majority of them in the first years of life have accelerated growth rates, allowing the child to normalize their weight-growth indicators and catch up in the development of peers. In the absence of an accelerated growth rates, children have a high risk of lagging behind in physical development throughout childhood, achieving low final growth and becoming short adults. In addition, the fact of birth with small body sizes is associated with a number of hormonal and metabolic features, a risk of metabolic syndrome in adult years.It is assumed that the absence of postnatal growth acceleration is due to various damages to the GH-IGF1 axis (partial GH deficiency, partial resistance to GH, partial resistance to IGF1). Growth hormone therapy, initiated early in life, is able to normalize growth rates in childhood and ultimately significantly improve or normalize the final growth of short stature children born small for gestational age.
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Affiliation(s)
- Е. В. Нагаева
- Национальный медицинский исследовательский центр эндокринологии
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26
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Ifatunji MA, Faustin Y, Lee W, Wallace D. Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159166. [PMID: 35954520 PMCID: PMC9367942 DOI: 10.3390/ijerph19159166] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.
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Affiliation(s)
- Mosi Adesina Ifatunji
- Departments of African American Studies and Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 53706, USA
- Correspondence:
| | - Yanica Faustin
- Department of Public Health Studies, College of Arts and Sciences, Elon University, Elon, NC 27244, USA;
| | - Wendy Lee
- Department of Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 54706, USA;
| | - Deshira Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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Jacobson MH, Wang Y, Long SE, Liu M, Ghassabian A, Kahn LG, Afanasyeva Y, Brubaker SG, Mehta-Lee SS, Trasande L. The Effect of Maternal US Nativity on Racial/Ethnic Differences in Fetal Growth. Am J Epidemiol 2022; 191:1568-1583. [PMID: 35434731 PMCID: PMC9618163 DOI: 10.1093/aje/kwac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/01/2022] [Accepted: 04/06/2022] [Indexed: 01/29/2023] Open
Abstract
While racial/ethnic differences in fetal growth have been documented, few studies have examined whether they vary by exogenous factors, which could elucidate underlying causes. The purpose of this study was to characterize longitudinal fetal growth patterns by maternal sociodemographic, behavioral, and clinical factors and examine whether associations with maternal race/ethnicity varied by these other predictors. Between 2016 and 2019, pregnant women receiving prenatal care at NYU Langone Health (New York, New York) were invited to participate in a birth cohort study. Women completed questionnaires, and clinical data were abstracted from ultrasound examinations. Maternal characteristics were assessed in relation to fetal biometric measures throughout pregnancy using linear mixed models. Maternal race/ethnicity was consistently associated with fetal biometry: Black, Hispanic, and Asian women had fetuses with smaller head circumference, abdominal circumference, and biparietal diameter than White women. The associations between race/ethnicity and fetal growth varied by nativity for Asian women, such that the disparity between Asian and White women was much greater for US-born women than for foreign-born women. However, associations for Black and Hispanic women did not vary by nativity. While race/ethnicity-specific fetal growth standards have been proposed, additional work is needed to elucidate what could be driving these differences, including factors that occur in parallel and differentially affect fetal growth.
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Affiliation(s)
- Melanie H Jacobson
- Correspondence to Dr. Melanie H. Jacobson, Department of Pediatrics, Grossman School of Medicine, New York University, 227 East 30th Street, 8th Floor, New York, NY 10016 (e-mail: )
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Pearlman J, Robinson DE. State Policies, Racial Disparities, and Income Support: A Way to Address Infant Outcomes and the Persistent Black-White Gap? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:225-258. [PMID: 34522974 DOI: 10.1215/03616878-9517205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low birth weight and preterm births vary by state, and Black mothers typically face twice the risk that their white counterparts do. This gap reflects an accumulation of psychosocial and material exposures that include interpersonal racism, differential experience with area-level deprivation such as residential segregation, and other harmful exposures that the authors refer to as "institutional" or "structural" racism. The authors use logistic regression models and a dataset that includes all births from 1994 to 2017 as well as five state policies from this period-Aid to Families with Dependent Children/Temporary Aid for Needy Families, housing assistance, Medicaid, minimum wage, and the earned income tax credit (EITC)-to examine whether these state social policies, designed to provide a financial safety net, are associated with risk reduction of low birth weight and preterm birth to Black and white mothers, and whether variations in state generosity attenuate the racial inequalities in birth outcomes. The authors also examine whether the relationship between state policies and racial inequalities in birth outcomes is moderated by the education level of the mother. We find that the EITC reduces the risk of low birth weight and preterm birth for Black mothers. The impact is much less consistent for white mothers. For both Black and white mothers, the benefits to birth outcomes are larger for mothers with less education.
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Understanding and Reducing Persistent Racial Disparities in Preterm Birth: a Model of Stress-Induced Developmental Plasticity. Reprod Sci 2022; 29:2051-2059. [PMID: 35298790 DOI: 10.1007/s43032-022-00903-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial disparities in the US. Despite efforts to reduce preterm birth, rates have risen and racial disparities persist. Maternal stress is a risk factor for preterm birth; however, often, it is treated as a secondary variable rather than a primary target for intervention. Stress is known to affect several biological processes leading to downstream sequelae. Here, we present a model of stress-induced developmental plasticity where maternal stress is a key environmental cue impacting the length of gestation and therefore a primary target for intervention. Black women experience disproportionate and unique maternal stressors related to perceived racism and discrimination. It is therefore not surprising that Black women have disproportionate rates of preterm birth. The downstream effects of racism on preterm birth pathophysiology may reflect an appropriate response to stressors through the highly conserved maternal-fetal-placental neuroendocrine stress axis. This environmentally sensitive system mediates both maternal stress and the timing of birth and is a mechanism by which developmental plasticity occurs. Fortunately, stress does not appear to be an all-or-none variable. Evidence suggests that developmental plasticity is dynamic, functioning on a continuum. Therefore, simple, stress-reducing interventions that support pregnant women may tangibly reduce rates of preterm birth and improve birth outcomes for all women, particularly Black women.
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30
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Racism and the Reproductive Health Experiences of U.S.-Born Black Women. Obstet Gynecol 2022; 139:407-416. [PMID: 35115434 DOI: 10.1097/aog.0000000000004675] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore Black women's lived experiences of racism and the associated effects on reproductive health decisions and the reproductive health care experience. METHODS We recruited participants through social media and community outreach. We conducted semi-structured individual interviews focusing on Black women's lived experiences of racism and their effects on reproductive health. We coded and analyzed interview transcripts using process coding methodology. RESULTS Participants (N=21) were 21-45 years old and from Boston, Chicago, and Atlanta. Our primary themes were: 1) reproductive health racism across the life course, 2) anti-Black racism in the reproductive health care system, and 3) self-protective actions when interacting with the reproductive health care system. Reproductive racism across the life course included subthemes of early sexualization of Black women, heightened awareness of reproductive health inequities, and knowledge of reproductive oppression. Anti-Black racism in the reproductive health care system included subthemes of absence of shared decision making; vicarious reproductive health experiences; stereotyping, invalidation, and dismissal by reproductive health professionals; and medical mistrust. Participants guarded themselves against racism within reproductive health care by engaging in a variety of self-protective actions including seeking a health care professional of color, overpreparing for their appointments, enlisting advocates, seeking care only when desperate, and heightening symptoms to be heard. CONCLUSION Personal, vicarious, and historical experiences of racism within reproductive health care triggered participants to perform self-protective actions when interacting with the reproductive health care system. These actions served to promote safety, autonomy and rehumanization within a system that has historically and contemporarily devalued Black reproductive health.
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Collins JW, David RJ. Black Babies Matter. Clin Perinatol 2022; 49:93-101. [PMID: 35210011 DOI: 10.1016/j.clp.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite dramatic advancements in neonatal intensive care since the 1960s, African-American infants still have more than a two-fold higher first-year mortality rate than non-Latinx White infants. Our essay examines the impact of upstream factors closely linked to the historical and contemporary context of structural racism in the United States on the African-American women's birth outcome disadvantage. In the process, we propose a paradigm to address the racial health inequity in adverse birth outcome by considering the interplay of racism and social class.
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Affiliation(s)
- James W Collins
- Neonatal Intensive Care Unit, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Box 45, 225 E. Chicago Avenue, Chicago, IL 60611, USA.
| | - Richard J David
- Division of Neonatology, Stroger Hospital of Cook County, University of Illinois at Chicago College of Medicine, 1969 Ogden Avenue, Chicago, IL 60612, USA
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Hwang SS. The Limitations of Race/Ethnicity Categories in Reporting and Addressing (Disparities in Perinatal Health Outcomes. J Pediatr 2022; 240:9-10. [PMID: 34752808 DOI: 10.1016/j.jpeds.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Adegoke TM, Pinder LF, Ndiwane N, Parker SE, Vragovic O, Yarrington CD. Inequities in Adverse Maternal and Perinatal Outcomes: The Effect of Maternal Race and Nativity. Matern Child Health J 2021; 26:823-833. [PMID: 34424456 DOI: 10.1007/s10995-021-03225-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effect of race and ethnicity on differences in maternal and perinatal outcomes among U.S.-born and foreign-born women, as well as racial and ethnic disparities in outcomes within these groups. METHODS This retrospective study analyzed singleton pregnancies (n = 11,518) among women delivering at Boston Medical Center from January 2010-March 2015. Outcomes of interest included preterm birth, early preterm birth, cesarean delivery, hypertensive disorders, diabetes, low birth weight at term (LBW, < 2500 g), NICU admission and intrauterine fetal demise (IUFD). Prevalence ratios and 95% confidence intervals comparing outcomes between U.S.- and foreign-born women were calculated and stratified by race. Obstetric outcomes among Black and Hispanic women were compared to those of white women within both U.S.- and foreign-born groups. RESULTS Preterm birth, hypertensive disorders, LBW and NICU admission were more likely to occur among U.S.-born women and their neonates compared to foreign-born women. Controlling for sociodemographic characteristics did not significantly impact these disparities. Among foreign-born women, Black women had a higher prevalence of many maternal and neonatal complications, while Hispanic women had a lower prevalence of some complications compared to white women. Black woman and infants consistently exhibit worse outcomes regardless of their nativity, while Hispanic women foreign-born women experience less disparate outcomes. CONCLUSIONS FOR PRACTICE Overall, women born in the United States are at higher risk of several adverse perinatal outcomes compared to foreign-born women. Racial and ethnic disparities in birth outcomes exist in both groups. However, the complex interplay between biopsychosocial influences that mediate these inequities appear to have different effects among U.S- and foreign- born women. A better understanding of these factors can be used to combat disparities and improve outcomes for all women.
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Affiliation(s)
- Tejumola M Adegoke
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA.
| | - Leeya F Pinder
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Olivera Vragovic
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Christina D Yarrington
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
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35
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Hanna-Attisha M, Gonuguntla A, Peart N, LaChance J, Taylor DK, Chawla S. Umbilical Cord Blood Lead Level Disparities between Flint and Detroit. Am J Perinatol 2021; 38:e26-e32. [PMID: 32143224 DOI: 10.1055/s-0040-1705135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The lead-in-water impact of the Flint water crisis on the youngest and most neurodevelopmentally vulnerable population was largely unknown. The objective of this study was to investigate and compare cord blood lead levels (CBLLs) in newborns in Flint, Michigan, after the Flint water crisis, to a group of Detroit newborns. STUDY DESIGN Mothers of 99 Flint newborns were surveyed about potential lead exposures. These neonates were born after the recognition of population-wide lead-in-water contamination. CBLLs were measured and maternal-fetal metrics were reviewed. CBLLs and maternal-fetal metrics were then compared with those of a retrospective cohort of 116 Detroit newborns who previously shared the same water source. Analysis involved descriptive statistics, independent t-test, and χ 2 analysis. RESULTS CBLLs greater than or equal to 1 μg/dL (0.05 μmol/L) were more prevalent among Flint newborns (14%), as compared with Detroit newborns (2%; p = 0.001). This was a sevenfold disparity between Flint and Detroit newborns. No statistically significant differences were found in birth weight, head circumference, small for gestational age status, gestational age, or preterm status among the two groups. CONCLUSION The Flint water crisis potentially exposed newborns to lead in utero, implicating maternal-fetal outcomes and future health and development. Primary prevention efforts, including identification and mitigation of lead exposure before conception and during pregnancy, are needed. New environmental exposure detection methods and long-term neurodevelopmental follow-up will complement the findings of this study.
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Affiliation(s)
- Mona Hanna-Attisha
- Pediatric Residency Program, Hurley Children's Hospital at Hurley Medical Center, Flint, Michigan.,Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Flint, Michigan
| | - Ashweena Gonuguntla
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Flint, Michigan.,Newborn Nursery, Hurley Children's Hospital at Hurley Medical Center, Flint, Michigan
| | - Nadine Peart
- Pediatric Residency Program, Hurley Children's Hospital at Hurley Medical Center, Flint, Michigan.,Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Flint, Michigan
| | - Jenny LaChance
- Research, Hurley Medical Center, Flint, Michigan.,Office of Medical Education Research and Development, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - D Kay Taylor
- Research, Hurley Medical Center, Flint, Michigan.,Office of Medical Education Research and Development, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Sanjay Chawla
- Department of Pediatrics, Hutzel Women's Hospital and Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
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Abstract
Social disadvantage impacts the health of women and newborns throughout the life course. Contributing factors such as low educational attainment, unemployment, poverty, and lack of health insurance disproportionately affects minority women of reproductive age in the United States. This article reviews social disadvantage as it contributes to health status and health disparities for mothers and newborns in the United States and highlights the opportunities to improve social and structural determinants of health to address these gaps.
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Affiliation(s)
- Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-74, Atlanta, GA 30341, United States.
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Christian LM, Webber S, Gillespie S, Strahm AM, Schaffir J, Gokun Y, Porter K. Maternal Depressive Symptoms, Sleep, and Odds of Spontaneous Early Birth: Implications for Racial Inequities in Birth Outcomes. Sleep 2021; 44:6279824. [PMID: 34019675 DOI: 10.1093/sleep/zsab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Delivery prior to full term affects 37% of US births, including ~400,000 preterm births (<37 weeks) and >1,000,000 early term births (37-38 weeks). Approximately 70% of cases of shortened gestation are spontaneous - without medically-indicated cause. Elucidation of modifiable behavioral factors would have considerable clinical impact. METHODS This study examined the role of depressive symptoms and sleep quality in predicting the odds of spontaneous shortened gestation among 317 women (135 Black, 182 White) who completed psychosocial assessment in mid-pregnancy. RESULTS Adjusting for key covariates, Black women had 1.89 times higher odds of spontaneous shortened gestation compared to White women (OR (95% CI) = 1.89 (1.01, 3.53), p=0.046). Women who reported only poor subjective sleep quality (PSQI > 6) or only elevated depressive symptoms (CES-D ≥ 16) exhibited no statistically significant differences in odds of spontaneous shortened gestation compared to those with neither risk factor. However, women with comorbid poor sleep and depressive symptoms exhibited markedly higher odds of spontaneous shortened gestation than those with neither risk factor [39.2% versus 15.7%, [OR (95% CI) = 2.69 (1.27, 5.70), p = 0.01]. A higher proportion of Black women met criteria for both risk factors (23% of Black women versus 11% of White women; p=0.004), with a lower proportion experiencing neither risk factor (40.7% of Black versus 64.3% of White women; p < 0.001). CONCLUSIONS Additive effects of poor subjective sleep quality and depressive symptoms were observed with markedly higher odds of spontaneous shortened gestation among women with both risk factors. Racial inequities in rates of comorbid exposure corresponded with inequities in shortened gestation. Future empirical studies and intervention efforts should consider the interactive effects of these commonly co-morbid exposures.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Department of Psychology, The Ohio State University, Columbus, OH, USA.,Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shannon Webber
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Anna M Strahm
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan Schaffir
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
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Amaro H, Sanchez M, Bautista T, Cox R. Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism. Neuropharmacology 2021; 188:108518. [PMID: 33716076 PMCID: PMC8126433 DOI: 10.1016/j.neuropharm.2021.108518] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.
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Affiliation(s)
- Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, United States.
| | - Mariana Sanchez
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, United States.
| | - Tara Bautista
- Yale Stress Center, School of Medicine, Yale University, United States.
| | - Robynn Cox
- Suzanne Dworak-Peck School of Social Work, Schaeffer Center for Health Policy and Economics, And Edward R. Roybal Institute on Aging, University of Southern California, United States.
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Raper MJ, McDonald S, Johnston C, Isler C, Newton E, Kuehn D, Collier D, Broskey NT, Muldrow A, May LE. The influence of exercise during pregnancy on racial/ethnic health disparities and birth outcomes. BMC Pregnancy Childbirth 2021; 21:258. [PMID: 33771102 PMCID: PMC8004415 DOI: 10.1186/s12884-021-03717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Non-Hispanic black (NHB) pregnant women disproportionately experience adverse birth outcomes compared to Non-Hispanic white (NHW) pregnant women. The positive effects of prenatal exercise on maternal and neonatal health may mitigate these disparities. This study evaluated the influence of prenatal exercise on racial/ethnic disparities in gestational age (GA), birthweight (BW), and risks of preterm birth (PTB), cesarean section (CS), and low-birthweight (LBW) neonates. Methods This study performed a secondary data analysis using data from a 24-week, two-arm exercise intervention trial (ENHANCED by Mom). Women with singleton pregnancies (< 16 weeks), aged 18–40 years, BMI between 18.5–34.99 kg/m2, and no preexisting health conditions were eligible. The aerobic exercisers (EX) participated in 150 min of moderate-intensity weekly exercise while non-exercising controls (CON) attended low-intensity stretching/breathing sessions. Data on GA, PTB (< 37 weeks), BW, LBW (< 2.5 kg), and delivery mode were collected. Poisson, median and linear regressions were performed. Results Participants with complete data (n = 125) were eligible for analyses (EX: n = 58, CON: n = 67). NHB pregnant women delivered lighter neonates (β = − 0.43 kg, 95% CI: − 0.68, − 0.18, p = 0.001). After adjusting for prenatal exercise, racial/ethnic disparities in BW were reduced (β = − 0.39 kg, 95% CI: − 0.65, − 0.13, p = 0.004). Prenatal exercise reduced borderline significant racial/ethnic disparities in PTB (p = 0.053) and GA (p = 0.07) with no effects found for CS and LBW. Conclusions The findings of this study demonstrate that prenatal exercise may attenuate the racial/ethnic disparities observed in neonatal BW, and possibly GA and PTB. Larger, diverse samples and inclusion of maternal biomarkers (e.g., cytokines) are encouraged to further evaluate these relationships.
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Affiliation(s)
- Madigan J Raper
- Department of Business, East Carolina University (ECU), 1851 MacGregor Downs Rd, MS#701, Greenville, NC, 27834, USA.,Department of Kinesiology, ECU, Greenville, NC, USA
| | - Samantha McDonald
- Department of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Carol Johnston
- Department of Human Development and Family Science, ECU, Greenville, NC, USA
| | - Christy Isler
- Department of Obstetrics and Gynecology, ECU, Greenville, NC, USA
| | - Edward Newton
- Department of Obstetrics and Gynecology, ECU, Greenville, NC, USA
| | - Devon Kuehn
- Department of Pediatrics, ECU, Greenville, NC, USA
| | | | | | | | - Linda E May
- Department of Kinesiology, ECU, Greenville, NC, USA. .,Department of Human Development and Family Science, ECU, Greenville, NC, USA. .,Department of Foundational Sciences and Research, ECU, Greenville, NC, USA.
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Geographic Variation in Reproductive Health Among the Black Population in the US: An Analysis of Nativity, Region of Origin, and Division of Residence. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-020-09629-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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High Black infant mortality in Wisconsin: factors associated with the ongoing racial inequity. J Perinatol 2021; 41:212-219. [PMID: 33339984 DOI: 10.1038/s41372-020-00906-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Wisconsin has the highest Black infant mortality rate (IMR) in the nation. OBJECTIVE Evaluate factors associated with racial inequity in IMR in Wisconsin. STUDY DESIGN Births/deaths/IMR for Black and White infants from 2011 to 2016 were obtained from the Wisconsin Interactive Statistics on Health system, stratified by gestational age (GA), and compared using direct adjustment method. IMR were compared based on cause of death, maternal age, and education. RESULTS Crude and adjusted IMR was 13.7 and 9.1 for black infants. Respective IMR for white infants was 4.8 and 5.3. Crude IMR was 180% higher in Black infants. After controlling for GA, IMR among Black infants was 70% higher. In term Black infants, deaths due to sudden infant death syndrome (SIDS), accidents, and assaults were markedly high. CONCLUSIONS Higher IMR in Black infants was due to increased premature births and increased mortality among term infants. Potentially modifiable causes of death were SIDS, accidents, and assaults.
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Riggan KA, Gilbert A, Allyse MA. Acknowledging and Addressing Allostatic Load in Pregnancy Care. J Racial Ethn Health Disparities 2021; 8:69-79. [PMID: 32383045 PMCID: PMC7647942 DOI: 10.1007/s40615-020-00757-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
The USA is one of the few countries in the world in which maternal and infant morbidity and mortality continue to increase, with the greatest disparities observed among non-Hispanic Black women and their infants. Traditional explanations for disparate outcomes, such as personal health behaviors, socioeconomic status, health literacy, and access to healthcare, do not sufficiently explain why non-Hispanic Black women continue to die at three to four times the rate of White women during pregnancy, childbirth, or postpartum. One theory gaining prominence to explain the magnitude of this disparity is allostatic load or the cumulative physiological effects of stress over the life course. People of color disproportionally experience social, structural, and environmental stressors that are frequently the product of historic and present-day racism. In this essay, we present the growing body of evidence implicating the role of elevated allostatic load in adverse pregnancy outcomes among women of color. We argue that there is a moral imperative to assign additional resources to reduce the effects of elevated allostatic load before, during, and after pregnancy to improve the health of women and their children.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Anna Gilbert
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
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Shour A, Garacci E, Palatnik A, Dawson AZ, Anguzu R, Walker RJ, Egede L. Association between pregestational diabetes and mortality among appropriate-for-gestational age birthweight infants. J Matern Fetal Neonatal Med 2021; 35:5291-5300. [PMID: 33517824 DOI: 10.1080/14767058.2021.1878142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND/OBJECTIVE Existing studies have shown that pregestational diabetes is a significant risk factor for adverse birth outcomes. However, it is unclear, whether pregestational diabetes and neonatal birthweight that is appropriate for the gestational age (AGA), a proxy for overall adequate glycemic control, is associated with higher infant mortality. To address this controversy, this study investigated the relationship between pregestational diabetes and infant mortality in appropriate-for-gestational age infants in the United States. METHODS Data from the National Vital Statistics System-Linked Birth-Infant Death dataset, including 6,962,028 live births between 2011 and 2013 were analyzed. The study was conducted in the US and data were analyzed in Milwaukee, Wisconsin. The outcome was mortality among AGA newborns, defined as annual deaths per 1000 live births with birthweights between the 10th and 90th percentiles for gestational age delivering at ≥37 weeks. The exposure was pregestational diabetes. Covariates were maternal demographics, behavioral/clinical, and infant factors. Logistic regression was used with p values <.05 considered statistically significant. RESULTS A total of 6,962,028 live births met inclusion criteria. Of these, a total of 11,711 (1.0%) term AGA birthweight infants died before their first birthday. About 35,689 (0.5%) mothers were diagnosed with pregestational diabetes prior to pregnancy with 0.3% of infants whose mothers had diabetes dying in their first year of life. In the unadjusted model, pregestational diabetes had a significant association with increased odds of mortality in term AGA infants (OR: 1.9, 95% CI: 1.6 - 2.3). AGA mortality remained significantly higher for women with pregestational diabetes compared to controls, after adjusting for maternal demographics (OR: 1.9, 95% CI: 1.6-2.3), behavioral/clinical characteristics (OR: 1.6, 95% CI: 1.3-2.0), and infant factors (OR: 1.3, 95% CI: 1.1-1.6). CONCLUSIONS In term pregnancies, pregestational diabetes was significantly associated with 30% higher mortality among AGA birthweight infants. Our study is innovative in its focus on AGA infants that overall is associated with good maternal glycemic control during pregnancy and in theory should confer a risk for infant mortality that is similar to pregnancies not complicated by pregestational diabetes. Despite this, we still found that even term AGA infants have higher risk of mortality in the setting of maternal pregestational diabetes. Implications of our findings underscore the importance of close antepartum surveillance and optimization of glycemic control preconception, identification of treatment targets, and health policies to reduce infant mortality. The results from this study may assist other researchers and clinicians understand how best to target future interventions to reduce term infant mortality and the burden of pregestational diabetes in the United States.
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Affiliation(s)
- Abdul Shour
- Medical College of Wisconsin, Institute for Health and Equity, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ronald Anguzu
- Medical College of Wisconsin, Institute for Health and Equity, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Ekeke P, Rankin K, DeSisto C, Collins JW. The Excess Preterm Birth Rate Among US-Born (Compared to Foreign-Born) Black Women: The Role of Father's Education. Matern Child Health J 2021; 26:845-852. [PMID: 33507477 DOI: 10.1007/s10995-020-03117-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To ascertain the component of the excess preterm birth (< 37 weeks, PTB) rate among US-born (compared to foreign-born) Black women attributable to differences in acknowledged father's education attainment. METHODS Stratified analyses and Oaxaca-Blinder decomposition methods were performed on the 2013 National Center for Health Statistics birth certificate files of singleton infants with acknowledged fathers. RESULTS US-born Black women (N = 196,472) had a PTB rate of 13.3%, compared to 10.8% for foreign-born Black women (N = 51,334; Risk Difference (95% confidence interval) = 2.5 (2.3, 2.8). Infants of US-born black women had a greater a percentage of fathers with a high school diploma or less and a lower percentage of fathers with bachelor's degrees or higher than their counterparts of foreign-born women. In both subgroups, PTB rates tended to decline as the level of paternal education attainment rose. In an Oaxaca model (controlling for maternal age, education, marital status, parity, adequacy of prenatal care utilization, and chronic medical conditions), differences in paternal education attainment explained 15% of the maternal nativity disparity in PTB rates. In contrast, maternal education attainment accounted for approximately 4% of the disparity in PTB rates. CONCLUSIONS FOR PRACTICE Acknowledged father's low level of education attainment, or something closely related to it, explains a notable proportion of the disparity in PTB rates between US-born and foreign-born Black women.
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Affiliation(s)
- Paris Ekeke
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, #45, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Kristin Rankin
- School of Public Health, Department of Epidemiology, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Carla DeSisto
- School of Public Health, Department of Epidemiology, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - James W Collins
- Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, #45, 225 E. Chicago Ave, Chicago, IL, 60611, USA.
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Fonseca JM, Silva AAM, Rocha PRH, Batista RLF, Thomaz EBAF, Lamy-Filho F, Barbieri MA, Bettiol H. Racial inequality in perinatal outcomes in two Brazilian birth cohorts. ACTA ACUST UNITED AC 2021; 54:e10120. [PMID: 33503156 PMCID: PMC7822460 DOI: 10.1590/1414-431x202010120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to estimate and compare racial inequality in low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR) in two Brazilian birth cohorts. This was a cross-sectional study nested within two birth cohorts in Ribeirão Preto (RP) and São Luís (SL), whose mothers were interviewed from January to December 2010. In all, 7430 (RP) and 4995 (SL) mothers were interviewed. The maternal skin color was the exposure variable. Associations were adjusted for socioeconomic and biological covariates: maternal education, per capita family income, family economic classification, household head occupation, maternal age, parity, marital status, prenatal care, type of delivery, maternal pre-pregnancy BMI, hypertension, hypertension during pregnancy, and smoking during pregnancy collected from questionnaires applied at birth. Statistical analysis was done with the chi-squared test and logistic regression. In RP, newborns from mothers with black skin color had a higher risk of LBW and IUGR, even after adjusting for socioeconomic and biological variables (P<0.001). In SL, skin color was not a risk factor for LBW (P=0.859), PTB (P=0.220), and IUGR (P=0.062), before or after adjustment for socioeconomic and biological variables. The detection of racial inequality in these perinatal outcomes only in the RP cohort after adjustment for socioeconomic and biological factors may be reflecting the existence of racial discrimination in the RP society. In contrast, the greater miscegenation present in São Luís may be reflecting less racial discrimination of black and brown women in this city.
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Affiliation(s)
- J M Fonseca
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - A A M Silva
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - P R H Rocha
- Departamento de Pediatria e Puericultura, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R L F Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - E B A F Thomaz
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - F Lamy-Filho
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - M A Barbieri
- Departamento de Pediatria e Puericultura, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - H Bettiol
- Departamento de Pediatria e Puericultura, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Abuelezam NN, Cuevas AG, El-Sayed AM, Galea S, Hawkins SS. Infant Health for Arab and Non-Arab Mothers Identifying as White, Black, or Other in Massachusetts. Am J Prev Med 2021; 60:64-71. [PMID: 33019995 DOI: 10.1016/j.amepre.2020.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study quantifies the differences in infant outcomes by mother's self-identified race among Arab Americans and by self-identified race and ethnicity for Arabs and non-Arabs. METHODS This study used data from the Standard Certificate of Live Birth on 8,204 infants born to Arab and 325,354 infants born to non-Arab mothers between 2012 and 2016 in Massachusetts; data were analyzed between 2019 and 2020. Mothers' race was categorized as White, Black, or Other. Mothers' ethnicity was categorized as Arab or non-Arab. Outcomes included birth weight, preterm birth, low-birth weight, small for gestational age, and large for gestational age. Linear and logistic regression models assessed the association between race and infant health outcomes. RESULTS Black Arab mothers had higher odds of preterm birth (AOR=1.37, 95% CI=1.07, 1.76) and low-birth weight (AOR=1.35, 95% CI=0.99, 1.84) than White Arab mothers. Arab mothers who self-identified as Other had babies that were 51.4 grams lighter than babies born to White Arab mothers. White Arab mothers had higher odds of low birth weight (AOR=1.19, 95% CI=1.06, 1.34) and small-for-gestational-age babies (AOR=1.22, 95% CI=1.11, 1.36) but lower odds of large-for-gestational-age babies (AOR=0.77, 95% CI=0.70, 0.86) than White non-Arab mothers. CONCLUSIONS Both ethnicity and race are important determinants of the health of Arab American infants. Arab ethnicity may play a negative role in the infant health of Arab Americans who identify as White. A better understanding of the lived experiences of Arab American mothers, with regard to their racial and ethnic identity, may help better inform clinical practice.
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Affiliation(s)
- Nadia N Abuelezam
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.
| | - Adolfo G Cuevas
- Department of Community Health, Tufts University, Medford, Massachusetts
| | - Abdulrahman M El-Sayed
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts
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Santri IN, Jiang CB, Chen YH, Wu CD, Zou ML, Chien LC, Lo YC, Chao HJ. Associations of birth outcomes with air pollution and land use characteristics in the Greater Taipei Area. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 750:141579. [PMID: 32853937 DOI: 10.1016/j.scitotenv.2020.141579] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Understanding the effects of environmental factors on birth outcomes is crucial for public health because newborns' birth size affects their likelihood of childhood survival, risk of perinatal morbidity, and subsequent health and growth. Therefore, we investigated the associations of birth outcomes with prenatal air pollutant exposure and residential land use characteristics in the Greater Taipei Area. METHODS Participants were selected from the Longitudinal Examination across Prenatal and Postpartum Health in Taiwan study, which is an ongoing prospective study launched in July 2011. Parental sociodemographic data and medical histories were collected using standardized questionnaires. Mean air pollutant levels during each trimester were estimated using the spatial interpolation technique (Ordinary Kriging). Land use types surrounding participants' homes were evaluated within a designated radius of their residential addresses. We used multiple regressions to examine relationships between birth outcomes (i.e., birth weight, height, and head circumference) and environmental factors after adjustment for parental characteristics. RESULTS A total of 436 pregnant women-infant pairs were included. Birth weight was negatively associated with commercial land and greenhouse areas near the residence. Living near greenhouse areas negatively affected birth height, but higher greenness level within 100 m of the residence had a positive effect. Birth head circumference was only associated with sociodemographic factors in the multivariate model. CONCLUSION Land use types near the homes of pregnant women, but not exposure to air pollutants, were significantly associated with birth weight and height in the Greater Taipei Area. Increased greenness level was positively associated with birth height, and living near commercial or greenhouse areas had adverse effects on birth outcomes. Living in a healthy neighborhood is critical for the birth outcomes of infants and presumably their health in early childhood.
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Affiliation(s)
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Lun Zou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ling-Chu Chien
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lo
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan; Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hsing Jasmine Chao
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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Strully KW, Bozick R, Huang Y, Burgette LF. Employer Verification Mandates and Infant Health. POPULATION RESEARCH AND POLICY REVIEW 2020; 39:1143-1184. [PMID: 33281251 DOI: 10.1007/s11113-019-09545-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent decades, several states have enacted their own immigration enforcement policies. This reflects substantial variation in the social environments faced by immigrants and native-born citizens, and has raised concerns about unintended consequences. E-Verify mandates, which require employers to use an electronic system to ascertain legal status as a pre-requisite for employment, are a common example of this trend. Drawing on birth certificate data from 2007-2014, during which 21 states enacted E-Verify mandates, we find that these mandates are associated with a decline in birthweight and gestational age for infants born to immigrant mothers with demographic profiles matching the undocumented population in their state as well as for infants of native-born mothers. In observing negative trends for both immigrants and natives, our findings do not support the hypothesis that E-Verify has a distinct impact on immigrant health; however, the broader economic, political, and demographic contexts that coincide with these policies, which likely impact the broader community of both immigrants and natives, may pose risks to infant health.
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Affiliation(s)
- Kate W Strully
- University at Albany, SUNY, 1400 Washington Ave, AS 308, Albany, NY 12222
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Collier ARY, Ledyard R, Montoya-Williams D, Qiu M, Dereix AE, Farrokhi MR, Hacker MR, Burris HH. Racial and ethnic representation in epigenomic studies of preterm birth: a systematic review. Epigenomics 2020; 13:1735-1746. [PMID: 33264049 DOI: 10.2217/epi-2020-0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: We conducted a systematic review evaluating race/ethnicity representation in DNA methylomic studies of preterm birth. Data sources: PubMed, EMBASE, CINHAL, Scopus and relevant citations from 1 January 2000 to 30 June 2019. Study appraisal & synthesis methods: Two authors independently identified abstracts comparing DNA methylomic differences between term and preterm births that included race/ethnicity data. Results: 16 studies were included. Black and non-Hispanic Black deliveries were well represented (28%). However, large studies originating from more than 95% White populations were excluded due to unreported race/ethnicity data. Most studies were cross-sectional, allowing for reverse causation. Most studies were also racially/ethnically homogeneous, preventing direct comparison of DNA methylomic differences across race/ethnicities. Conclusion: In DNA methylomic studies, Black women and infants were well represented. However, the literature has limitations and precludes drawing definitive conclusions.
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Affiliation(s)
- Ai-Ris Y Collier
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.,Department of Obstetrics, Gynecology, & Reproductive Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Rachel Ledyard
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Diana Montoya-Williams
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Maylene Qiu
- Biomedical Library, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alexandra E Dereix
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Minou Raschid Farrokhi
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.,Colby College, Waterville, ME 04901, USA
| | - Michele R Hacker
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.,Department of Obstetrics, Gynecology, & Reproductive Biology, Harvard Medical School, Boston, MA 02115, USA.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Heather H Burris
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
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Shriner D, Bentley AR, Zhou J, Ekoru K, Doumatey AP, Chen G, Adeyemo A, Rotimi CN. Time-to-event modeling of hypertension reveals the nonexistence of true controls. eLife 2020; 9:62998. [PMID: 33258447 PMCID: PMC7707825 DOI: 10.7554/elife.62998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
Given a lifetime risk of ~90% by the ninth decade of life, it is unknown if there are true controls for hypertension in epidemiological and genetic studies. Here, we compared Bayesian logistic and time-to-event approaches to modeling hypertension. The median age at hypertension was approximately a decade earlier in African Americans than in European Americans or Mexican Americans. The probability of being free of hypertension at 85 years of age in African Americans was less than half that in European Americans or Mexican Americans. In all groups, baseline hazard rates increased until nearly 60 years of age and then decreased but did not reach zero. Taken together, modeling of the baseline hazard function of hypertension suggests that there are no true controls and that controls in logistic regression are cases with a late age of onset.
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Affiliation(s)
- Daniel Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
| | - Jie Zhou
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
| | - Kenneth Ekoru
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
| | - Ayo P Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
| | - Guanjie Chen
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, United States
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